The Cancer Survival Lottery

24 November 2011

More research needed as well as better long term care

A new study of cancer survival figures by leading cancer charity Macmillan Cancer Support has found that people now live nearly six times longer after their cancer diagnosis than was the case 40 years ago – median survival time has increased from one year to six years.[1]

But the research also shows that progress has been extremely patchy. For 11 of the 20 cancers studied median survival time is now predicted to be over five years. But for nine cancers, median survival time is three years or less, with little improvement since the 1970s.

Changes in median survival time show the real progress in how long people are living after their cancer diagnosis, rather than increases in the number of survivors at a certain point of time after diagnosis. Survival is usually presented as the number of people to reach certain markers; one, five or ten years after diagnosis. But big, proportional increases in the number of people reaching a particular milestone, sometimes means little or no actual improvement in the average survival time. By calculating the median survival time we know the number of years since diagnosis when half of patients are still alive.

Six cancers have median survival times of more than 10 years. There have been dramatic improvements in survival for some cancers like breast, colon, and Non-Hodgkin’s Lymphoma - with years added to median survival times. But there is little, if any, good news for other cancers like lung, brain, or pancreatic cancer, where median survival times are still counted in weeks rather than years.

Macmillan’s research found that:

Six of the cancers studied have predicted median survival times of more than 10 years

The biggest improvement has been for colon cancer with a 17-fold increase in median survival time from around seven months to ten years

Breast cancer median survival time has doubled since the 1970s and has been more than 10 years since at least the early 1990s

Lung and brain cancer median survival times has barely risen, from 11 to 20 weeks; and from 13 to 28 weeks respectively

Pancreatic cancer median survival time has increased by just three weeks (from nine to 12 weeks).

There has been great work on breast cancer treatments and this has had a clear impact on breast cancer survival. Though there has not been enough progress yet on dealing with the long-term consequences of breast cancer treatment. Neither has there been the same progress for lung, brain and pancreatic cancer median survival times - we need to up our game on these.

Research into breast cancer accounted for 20% of site-specific research funding in 2010 2, more than the combined spend on some of the cancers with the lowest median survival times – stomach, oesophagus, pancreas, brain and lung – which made up 13% of site-specific research finding in 2010.[2]

Ciarán Devane, Chief Executive of Macmillan Cancer Support, says:

‘This research is a huge breakthrough in seeing the real picture of how long people are living after a cancer diagnosis.

‘But the good news is tempered by the shocking variation between cancer types. Though we can celebrate increasing median survival times for some cancers such as breast and colon cancers, there has been lamentably poor progress made for lung and pancreatic cancer. It is clear that much, much more money needs to be put into research, surgery and treatment for the cancers with the poorest prognosis.

‘While it is wonderful news that more cancer patients are living longer overall, we also know they are not necessarily living well. Cancer treatment is the toughest fight many will ever face and patients are often left with long-term health and emotional problems long after their treatment has ended.3 For instance, of those colorectal cancer patients still alive between five and seven years after their diagnosis, two thirds (64%) will have an ongoing health problem.4

‘After treatment ends, many patients feel abandoned by the NHS as they struggle to cope with the long-term effects of cancer treatment. The NHS really needs to recognise cancer’s long-term impact on people’s lives, to plan better services and to develop more personalised care. We need services which keep people well and at home, not services which sort the problem when people arrive at A&E.’

Dr Diana Greenfield, a Macmillan Consultant Nurse at Weston Park Hospital, Sheffield, leads a service for patients with late effects from their cancer treatment. Diana says:

‘With modern cancer management, many more cancer patients are surviving cancer. Whilst this is good news, we are increasingly becoming more aware of the long-term and late effects of cancer and its treatment.

‘In our late effects clinic we do see patients who develop chronic health problems as a direct result of the treatment they received for cancer. Most problems are manageable if found early enough. That’s why assessing and screening patients in a timely and systematic way is becoming more important - either to help prevent problems altogether or decrease the impact.

‘We are beginning to consider how we best care for patients with treatment consequences. Simple measures, such as individual care plans and helping patients to make the right health choices for themselves, will help. We have got a lot of work to do but we are making progress.’

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Notes to Editors:

A copy of Macmillan’s research briefing paper Living After Diagnosis – Median Cancer Survival Times is available here.

1. Median survival time is the time since diagnosis when relative survival is at 50% and we interpret this as the time when half of the patients have survived (or half have died). Median survival time was calculated for people diagnosed in the periods 1971-72, 1980-81, 1990-91 and 2000-01, and predicted for those diagnosed in 2007. See research briefing paper for full details.Macmillan Cancer Support analysis based on London School of Hygiene and Tropical Medicine research.

2. Across government, charity and industry partners of the UK wide National Cancer Research Institute National Cancer Research Institute. Cancer Research Database (CaRD) 2010 - Data on cancer research funding by NCRI partners. http://www.ncri.org.uk/default.asp?s=1&p=3&ss=1 (Accessed November 2011)

4. Wells J., et al. Using clinical attendance patterns to determine likely survivorship journey in England. NCIN Conference 2011. Data analysis is provisional and subject to clinical validation. Data are for patients in England with a diagnosis of colorectal cancer in quarter 2 2001, followed up to the end of 2007. A sample of nearly 6,000 people were taken from the National Cancer Data Repository (NCDR).

These data relate to health problems as identified by NHS inpatient hospital activity. Through the NCDR patients’ registry data are linked to NHS inpatient hospital activity data to ascertain if patients are admitted to hospital and for what condition. Data analysis is provisional and subject to clinical validation.

About Macmillan Cancer Support:

Macmillan Cancer Support improves the lives of people affected by cancer, providing practical, medical, emotional and financial support. Working alongside people affected by cancer, Macmillan works to improve cancer care. More than one in three of us get cancer. Two million of us are living with it. If you are affected by cancer Macmillan can help.

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Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). A company limited by guarantee, registered in England and Wales company number 2400969. Isle of Man company number 4694F. Registered office: 89 Albert Embankment, London SE1 7UQ.